Background: Adults with hypertension are at increased risk of developing cardiovascular disease (CVD). Epidemiologic studies have suggested a protective effect of moderate alcohol consumption against CVD and death in the general population. However, because heavy alcohol use is a risk factor for developing hypertension, it is unclear if this protective effect applies to patients with hypertension as well. Beulens and colleagues examined the relationship between alcohol consumption and the incidence of nonfatal myocardial infarction (MI), cardiac death, and stroke in men with hypertension.

The Study: This prospective study followed a cohort of 11,711 male health professionals with hypertension in the United States from 1986 to 2002. Participants were between 40 and 75 years of age at the time of enrollment. Men were excluded from the study if they had preexisting CVD, stroke, or cancer; had hypertension diagnosed before 1975; provided incomplete information about alcohol consumption or lifestyle habits (e.g., smoking, physical activity, diet); or reported a substantial change in alcohol consumption in the preceding 10 years.

A questionnaire was administered in 1986, 1990, 1994, and 1998 that asked participants to estimate how much and how often they consumed beer, wine, and liquor. These estimates were compared with two one-week dietary records of 136 selected participants and were found to correlate well with actual alcohol consumption.

Primary outcomes were the incidences of nonfatal MI, cardiac death, and stroke. A physician who was blinded to the patient's history of alcohol consumption confirmed all events with a medical record or autopsy report review. MI that could not be confirmed by medical record review was classified as “probable” and was excluded in sensitivity analyses. Statistical methods were used to control for cardiac risk factors such as age, smoking status, body mass index, diabetes, and cholesterol levels. The analysis also was adjusted for standard measurement errors that result from self-reported nutritional data.

Results: During the follow-up period, 374 nonfatal and 279 fatal MIs occurred. An inverse relationship was found between the amount of alcohol consumed and the risk of MI. Consuming liquor was associated with a lower risk of MI than consuming beer or wine. There was no statistically significant association between alcohol consumption and the risk of ischemic stroke, cardiac death, or death from all causes.

Conclusion: The authors conclude that in men with hypertension, alcohol consumption decreases the risk of MI and does not affect cardiac or all-cause mortality. These results suggest that it is safe to continue drinking in moderation after a diagnosis of hypertension.